COVID-19 vaccine: Preparing for its arrival

UCLA Health pharmacists and ultra-cold freezers are ready and waiting as delivery nears.

After receiving emergency use authorization from the U.S. Food and Drug Administration on Dec. 11, the first batch of COVID-19 vaccines from Pfizer are being distributed across the country, with some 327,000 doses destined for California.

A portion of those doses are headed for UCLA Health, where the pharmacy staff stands ready to deal with ultra-cold freezers — the Pfizer vaccine needs to be kept at -70 degrees Celsius — and the ultra-precious medicine they’ll soon contain.

“We handle fragile and costly drugs 24-7-365,” says Jess De Jesus, PharmD, MBA-HCM, chief pharmacy officer for UCLA Health. “So we are used to handling drugs very carefully.”

Working with a history-making, life-saving, potentially pandemic-ending vaccine may be all in a day’s work for Dr. De Jesus and his team, but what makes the forthcoming vaccine shipment unusual is its temperature requirement and the amount of accompanying security.

The ultra-low temperatures are essential to preserve the efficacy of the vaccines, which rely on new technology using messenger RNA, a fragile method of delivering genetic information to cells.

Vaccines are being deployed with military precision and oversight by Operation Warp Speed, a partnership of the National Institutes of Health, the Department of Health and Human Services, the Department of Defense and other federal agencies and private firms. The Centers for Disease Control and Prevention issued a 55-page guide book in November with instructions for handling COVID-19 vaccines.

The low temperatures add a logistical challenge to what is already an unprecedented distribution effort. The vaccines will travel encased in dry ice until they reach the freezers that hospitals around the country have acquired specifically for their arrival.

UCLA Health purchased six additional ultra-cold freezers to house the vaccines at a temperature Dr. De Jesus describes as “colder than Antarctica.” These medical-grade freezers are electronically monitored for temperature consistency. Pharmacy and facilities workers will be notified upon any movement of more than a few degrees in either direction. The digital monitoring system automatically pages the pharmacy supervisor on duty if there’s any deviation in temperature, so that person can immediately move the drugs to another freezer if necessary.

Previously, UCLA Health kept one such ultra-cold freezer for investigational drugs, Dr. De Jesus says.

Pharmacists must use special gloves to handle the frozen Pfizer vaccine vials. The vaccine must be defrosted and a diluent — a saline solution to dilute the medication — needs to be added before the vaccine is administered. Each Pfizer vial contains five doses, Dr. De Jesus says. Once defrosted, they are good for five days under regular refrigeration. Once the diluent is added, they are good for six hours.

Eight additional pharmacists and pharmacy techs have been brought on board to handle distribution and documentation of the vaccines, he says. Nurses and other health personnel have been tapped to administer the shots.

The FDA is set to consider emergency use authorization of the Moderna COVID-19 vaccine on Dec. 17, with supplies to be shipped out shortly after approval. That formulation also requires freezing, but at a less-extreme temperature: -20 degrees Celsius, which can be maintained by standard freezers.